Inorganic nitrate reduces contrast-induced nephropathy following coronary angiography for acute coronary syndromes

A recent study demonstrated that for patients at risk of renal injury undergoing coronary angiography for acute coronary syndromes (ACS), a short (5-day) regimen of once-daily inorganic nitrate resulted in decreased contrast-induced nephropathy (CIN), enhanced kidney outcomes at 3 months, and reduced major adverse cardiovascular events (MACE) at 1 year when compared with individuals who received a placebo. This study’s results were published in the European Heart Journal.

The NITRATE-CIN trial was a double-blind, randomized, placebo-controlled trial that included a total of 640 patients. These patients were randomized to receive either once daily potassium nitrate (n= 319; 12 mmol) or placebo (n= 321; potassium chloride) capsules for a period of 5 days. The primary endpoint of the trial was the incidence of CIN based on KDIGO criteria. Secondary outcomes measured included kidney function (eGFR) at 3 months, rates of procedural myocardial infarction, and MACE at 12 months.

Inorganic nitrate treatment led to a significant decrease in the rates of CIN compared to the placebo (9.1% vs 30.5%). This difference remained even after adjusting for baseline creatinine levels and diabetes status. Additionally, the use of inorganic nitrate exhibited positive outcomes in secondary outcomes, including a lower incidence of procedural myocardial infarction (2.7% vs 12.5%), improved renal function at 3 months (between-group change in estimated glomerular filtration rate of 5.17), and a reduced occurrence of MACE at 1 year (9.1% vs. 18.1%) compared to the placebo group.

Thus, it can be concluded that a 5-day regimen of once-daily inorganic nitrate may be beneficial for patients undergoing coronary angiography for ACS. This treatment resulted in a decrease in CIN, improved kidney outcomes at 3 months, and reduced MACE at 1 year compared to those who received a placebo.